Ch 26 Nursing Care and Discharge Teaching

Circumcision

Newborn should be assessed for the following. ●A history of bleeding tendencies in the family (hemophilia and clotting disorders) ●Hypospadias or epispadias ●Ambiguous genitalia (when the newborn has genitalia that can include both male and female characteristics). ●Illness or infection. NURSING ACTIONS ●Signed informed consent form from parents is needed. ●Gather and prepare supplies. ●Administer medication to newborn as prescribed. ●Assist with procedure. -Place the newborn on the restraining board, and provide a radiant heat source to prevent cold stress. Do not leave the newborn unattended. Have bulb syringe readily available. -Comfort the newborn as needed. -Document time and type of circumcision, excessive bleeding, and newborn voiding Newborn should be assessed for... ●Bleeding every 15 to 30 min for the first hour and then hourly for the next 4 to 6 hr ●The first voiding NURSING ACTIONS ●Remove the newborn from the restraining board, and swaddle to provide comfort. Apply gauze lightly to penis if bleeding or oozing ●Fan-fold diapers to prevent pressure on the circumcised area. ●Liquid acetaminophen 10 to 15 mg/kg can be administered orally after the procedure and repeated every 4 to 6 hr as prescribed for a maximum of 30 to 45mg/kg/day Change the newborn's diaper at least every 4 hr, and clean the penis with warm water With clamp procedures, apply petroleum jelly with each diaper change for at least 24 hr after the circumcision to keep the diaper from adhering to the penis. ●Avoid wrapping the penis in tight gauze, which can impair circulation to the glans. ●A tub bath should not be given until the circumcision is healed. Until then, warm water should be trickled gently over the penis. ●Notify the provider if there is any redness, discharge, swelling, strong odor, tenderness, decrease in urination, or excessive crying from the newborn. ●Tell the parents that a film of yellowish mucus can form over the glans by day two, and it is important not to wash it off. ●Avoid using premoistened towelettes to clean the penis because they contain alcohol. ●Inform the parents that the newborn can be fussy or can sleep for several hours after the circumcision. Provide comfort measures for 24 to 48 hr, to include acetaminophen as prescribed. ●Inform the parents that the circumcision will heal completely within a couple of weeks

Circumcision Care

Informed consent is needed Contraindications: hypospadias, epispadias and family history disorders Do not bottle feed 4 hrs prior to procedure Circumcision should not be done immediately after birth because the low level of the newborns vitamin K Bleeding every 15 minutes for the first hour and then every hour for the first 12 hrs should be assessed

Home Safety

Never leave the newborn unattended with pets or other small children. ●Keep small objects (coins) out of the reach due to choking hazard. ●Never place the newborn on his stomach to sleep during the first few months of life. The back-lying position is the position of choice. The newborn can be placed on his abdomen when awake and being supervised. ●Never provide a newborn with a soft surface to sleep on (pillows or water bed). The newborn's mattress should be firm. Never put pillows, toys, bumper pads, or loose blankets in a crib. ●Do not tie anything around the newborn's neck. ●Monitor the safety of the newborn's crib. Crib or playpen should be away from window blinds and drapery cords. Newborns can become strangled in them. ●The bassinet or crib should be placed on an inner wall, not next to a window, to prevent cold stress by radiation. ●Smoke detectors should be on every floor of a home and should be checked monthly to ensure that they are working. Batteries should be changed twice a year. ●Eliminate potential fire hazards. Keep a crib and playpen away from heaters, radiators, and heat vents. ●Control the temperature and humidity of the newborn's environment by providing adequate ventilation. ●Avoid exposing the newborn to cigarette smoke ●All visitors should wash their hands before touching the newborn. Any individual who has an infection should be kept away ●Carefully handle the newborn. Do not toss the newborn up in the air or swing him by her extremities. ●Provide community resources to clients who can need additional and ongoing assessment and instruction on newborn care

Crying

Hungry Need to be burped Overstimulated Wet Cold/hot Tired Bored Do not feed newborn every time they cry

When can mothers and newborns be discharged?

When the newborn is 6-48 hrs old

A nurse is reviewing contraindications for circumcision with a newly hired nurse. Which of the following are contraindications? (SATA) A. Hypospadias B. Hydrocele C. Familiar history of hemophilia D. Hyperbilirubinemia E. Epispadias

A. Hypospadias C. Familiar history of hemophilia E. Epispadias

A nurse is caring for a newborn immediately following a circumcision using a Gomco procedure. Which of the following is an appropriate nursing intervention? A. Apply gel foam powder to site B. Place the newborn in prone position C. Apply petroleum gauze to site D. Avoid changing the diaper until the first voiding

C. Apply petroleum gauze to site rationale: to prevent diaper from sticking to penis

A nurse is providing discharge teaching to the parents of a newborn regarding circumcision care. Which of the following statements made by the parent indicates a need for further clarification? A. His circumcision will heal in a couple of weeks B. I do not need to remove the yellow mucus that will form C. I will clean his penis with each diaper change D. I will give him a tub bath within a couple of days

D. I will give him a tub bath within a couple of days

A nurse is reviewing care of the umbilical cord with the parent of a newborn. Which of the following should be included in the teaching? A. Cover the cord with a small gauze square B. Trickle clean water over the cord with each diaper change C. Apply hydrogen peroxide to the cord twice a day D. Keep the diaper folded below the cord

D. Keep the diaper folded below the cord

Signs of Illness to Report

Temp greater than 38° C (100.4° F) or less than 36.6° C (97.9° F) ●Poor feeding or little interest in food ●Forceful vomiting or frequent vomiting ●Decreased urination ●Diarrhea or decreased bowel movements ●Labored breathing with flared nostrils or an absence of breathing for greater than 15 seconds ●Jaundice ●Cyanosis ●Lethargy ●Inconsolable crying ●Difficulty waking ●Bleeding or purulent drainage around umbilical cord or circumcision ●Drainage developing in eyes